Hatyai Medical Education Center, Hatyai Hospital, 182 Rattakarn Road, Songkhla 90110, Thailand
Hatyai Hospital, 182 Rattakarn Road, Songkhla 90110, Thailand
Rural Remote Health. 2021 Oct;21(4):6883. doi: 10.22605/RRH6883. Epub 2021 Oct 15.
The longitudinal integrated clerkship (LIC) curriculum model focuses on patient-centered care and continuity of clinical and cultural learning between medical students, patients, clinicians, and a system of care. In rural settings, participating medical students are expected to have an interest in rural medicine and an involvement in the community. Many schools in the USA, Canada, and Australia have implemented LICs in undergraduate programs in different ways. However, a few published reports in Asia are available. This is the first report of a modified rural LIC in Thailand. The objective was to assess the educational environment of a rural LIC using the Dundee Ready Education Environment Measure (DREEM) questionnaire and to compare students' response on the basis of year of study and different sizes of hospitals.
A cross-sectional study was conducted. The study population comprised 75 clinical-year students in 2020. The modified LIC was implemented as part of integrated multidisciplinary rural clerkships for fourth-year students, and for fifth-year students undertaking clinical placements. Clinical clerkships in rural settings took place over 12 weeks for fourth-year students and over 14 weeks for fifth-year students. Practical exposure included the clinical areas of internal medicine, psychiatry, surgery, pediatrics, obstetrics and gynecology, emergency medicine, and family medicine, in outpatient and inpatient settings. The DREEM questionnaire was used to evaluate students' perceptions of learning climate. Data analysis was performed to determine the different size of hospitals and other factors associated with a favorable educational environment.
The response rate to the questionnaire was 96%. The overall DREEM score average was 137.7/200. Students' perceptions of learning and of teaching had mean scores of 30.1/48 and 35.7/44, respectively. Students' academic self-perceptions scored 18.7/32. Students' perceptions of atmosphere scored 30.4 of 48, and social self-perceptions scored 18.3/28. The academic subscale had the lowest percentage of scores regarded as confidence in knowledge gain. The factors associated with positive educational environment were staff as principal preceptors and large hospitals.
LIC implementation in a community health system is a model for expanding clinical clerkships. Good infrastructure of the host hospital and enthusiastic preceptors are the key success factors. Staff supervision is essential to encourage student learning, especially in academic environments. Large hospitals have better infrastructure to support learning processes than small hospitals.
纵向综合临床实习（LIC）课程模式侧重于以患者为中心的护理以及医学生、患者、临床医生和护理系统之间临床和文化学习的连续性。在农村地区，参与实习的医学生需要对农村医学感兴趣并参与社区活动。美国、加拿大和澳大利亚的许多学校都以不同的方式在本科课程中实施了 LIC，但亚洲只有少数已发表的报告。这是泰国首个农村 LIC 改良模式的报告。目的是使用邓迪教育环境测量（DREEM）问卷评估农村 LIC 的教育环境，并根据学习年限和不同规模的医院比较学生的反应。
本研究采用横断面研究。研究人群包括 2020 年的 75 名临床学年学生。改良后的 LIC 作为第四年学生综合多学科农村实习以及第五年学生临床实习的一部分实施。第四年学生的农村临床实习为期 12 周，第五年学生的实习为期 14 周。实践接触包括内科、精神病学、外科、儿科、妇产科、急诊医学和家庭医学等临床领域，涉及门诊和住院环境。使用 DREEM 问卷评估学生对学习氛围的看法。进行数据分析以确定不同规模的医院和其他与有利教育环境相关的因素。
问卷的回复率为 96%。DREEM 总分平均为 137.7/200。学生对学习和教学的看法平均得分为 30.1/48 和 35.7/44。学生的学术自我认知得分为 18.7/32。学生对氛围的看法得分为 30.4/48，对社会自我认知的得分为 18.3/28。学术子量表的得分最低，认为可以获得知识的信心。与积极教育环境相关的因素是教职员工作为主要导师和大医院。
在社区卫生系统中实施 LIC 是扩大临床实习的模式。宿主医院的良好基础设施和热情的导师是成功的关键因素。员工监督对于鼓励学生学习至关重要，尤其是在学术环境中。大医院比小医院拥有更好的基础设施来支持学习过程。
